Aims of the Project
The issue selected for this paper is focused on the reduction of the mortality rate among dialysis patients. This problem has been one of the major global concerns for many years. That way, its research is relevant and could be beneficial for public health in the future.
The area of specialization is a nurse practitioner, responsible for patient avocation/ education and disease management. The improved outcomes that are desired after the intervention implementation are a higher patient literacy in the population affected by kidney disease in terms of self-management, treatment compliance, lifestyle, and diet choices, as well as medication management. In other words, the question is will the patients who receive a high quality of care and are closely monitored last longer than the patients who just go to their regular evaluation? Below is the research question formulated using the PICOT (population, intervention, comparison, outcome, time).
PICOT question
In the population affected by kidney disease and end-stage renal disease (P), how does the high-quality primary care that includes renal diet education and medication management (I) delay the deterioration and development of the condition (O) compared to the patients receiving standard kidney disease care (C) in 5 years (T)?
Significance of the Issue
The issue of the growing dialysis population is of high significance at the global level; on the local scale, the United States has increasingly high rates of kidney disease that currently affects one out of ten people in the country (Kidney Disease Statistics for the United States, n.d.). Globally, the number of people affected by this condition is as high as 10% (The National Kidney Foundation, 2016).
Hogg et al. (2003) add that there is also a high incidence of poor patient outcomes at a very high cost. Namely, the primary kidney disease outcomes involve a risk of CVD and a progression to kidney failure or end-stage renal disease (ESRD) (Hogg et al., 2003). The latter involves a costly treatment with increased rates of morbidity (Anderson et al., 2009). As a result, the growth of the kidney disease population is to be slowed down for the improvement of public health worldwide and the reduction of healthcare costs.
The Iowa Model of Evidence-Based Practice to Promote Quality Care is one model to consider for this research. The major objective of the model is to help healthcare practitioners apply research findings in their everyday work and put the new strategies into practice (Brown, 2014). The model is based on the identification of the problem- or knowledge-based triggers where the change is required; further, the model recommends evaluation the importance of the issue, the development, and planning of the evidence-based change in practice; finally, a team of professionals is to be gathered to conduct a literature review based on the PICOT research question (Titler et al., 2001).
The selected body of literature is to be evaluated and critiqued in terms of findings and evidence reliability and validity. Based on the acquired information pilot change is designed with the chosen outcomes, guidelines, and baseline data that is further implemented using the pilot units. The evaluation of the change outcomes determines whether or not the change is suitable for adoption. Finally, the change is put into practice on a large scale, and its process and results are carefully monitored to determine its advantages and disadvantages and make adjustments in the future.
Search of the Literature for Evidence
The search for evidence started with the preparation of the PICO question on the topic relevant to the research. After the question has been formulated, the main goal was to select the most suitable information resources that will provide literature evidence for exploring the formulated PICO question. The US National Library of Medicine’s PubMed/Medline database was the first step in the selection of the material because it is one of the easiest websites that can be used in the process of evidence-based medicine literature selection (Bartkowiak, 2005, p. 39).
With the use of the Clinical Queries features for material extraction, it was possible to filter necessary resources from irrelevant resources. To begin the search for the necessary evidence-based literature on the topic of kidney disease, a relevant term was entered into the query box. Because the method of systematic reviews had shown potential in terms of locating various types of publications such as clinical trials and meta-analyses, it was implemented in the current search for relevant literature.
Other resources used for data search included EBM organizations websites such as the Cochrane Library, Bandolier, Clinical Evidence, and TRIP Database Plus. Despite that the websites contain a large selection of valuable evidence-based literature, there were some issues with the access since it required a subscription fee to use the search engines.
Other resources such as the American Academy of Pediatrics, NHS Evidence, University of Cambridge, Open Athens, and others were used for the literature search; however, some of them also provided difficulties in terms of free access to high-quality information.
Articles Appraisal
Hogg, R. J., Furth, S., Lemley, K. V., Portman, R., Schwartz, G., Coresh, J., Balk, E., Lau, J., Levin, A., Kausz, A., Eknoyan, G., & Levey, A. (2016). National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines for Chronic Kidney Disease in Children and Adolescents: Evaluation, Classification, and Stratification. Pediatrics, 111(6), 1416-1421.
Anderson, S., Halter, J., Hazzard, W., Himmelfarb, H., McFarland Horne, F., Kaysen, G., Kusek, J., Nayfield, S., Schmader, K., Tian, Y., Ashworth, J., Clayton, C., Parker, R., Tarver, E., Woolard, N., & High, K. (2009). Prediction, Progression, and Outcomes of Chronic Kidney Disease in Older Adults. JASN, 20(6), 1199-1209.
References
Bartkowiak, B. (2005). Searching for evidence-based medicine in the literature part 2: Resources. Clin Med Res, 3(1), 39-40.
Brown, C. G. The Iowa Model of Evidence-Based Practice to Promote Quality Care: An Illustrated Example in Oncology Nursing. Clinical Journal of Oncology Nursing, 18(2), 157-159.
Kidney Disease Statistics for the United States. (2016).
The National Kidney Foundation. (2015). Global Facts: About Kidney Disease.
Titler, M. G., Kleiber, C., Steelman, V. M., Rakel, B. A., Budreau, G., Everett, L.,… Goode, C. (2001). The Iowa Model of Evidence-Based Practice to Promote Quality Care. Critical Care Nursing Clinics of North America, 13(4), 497-509.